Advanced Bronchoscopy

Advanced Bronchoscopy Method

The development of flexible bronchoscopy has progressed immeasurably over the last 25 years, since it was first introduced by Dr S Ikeda, from Japan, as a novel alternative to the only method of visualising the airways thus far, that being rigid bronchoscopy under general anaesthesia. It allowed a greater viewing of the airway tree, even under conscious sedation, so making this one of the key diagnostic tools available to respiratory and intensive care clinicians. The improvements in bronchoscopic and imaging technology have led to a new sub speciality of interventional pulmonology, which incorporates diagnostic and therapeutic modalities for flexible bronchoscopy.

The diagnosis of common respiratory features/conditions such as lung cancer, persistent infections, opportunistic pneumonias, chronic cough, tuberculosis, certain interstitial lung diseases including sarcoidosis and organising pneumonia, are well established.

Advanced Bronchoscopy

Newer developments have led to many bronchoscopic diagnostic and therapeutic techniques in use and under evaluation. Endobronchial ultrasound allows transbronchial sampling of enlarged mediastinal lymph nodes for cancer diagnosis and staging, as well as for benign diseases. CT navigation bronchoscopy allows virtual tracking and marking of pulmonary lesions. Fluorescence bronchoscopy can identify precancerous lesions as part of surveillance bronchscopy in patients with a high risk of developing cancer.

Therapeutic procedures for palliative lung cancer debulking include diathermy, cryotherapy, argon plasma coagulation, photodynamic therapy and brachytherapy.

Bronchial thermoplasty for asthma is a novel mechanical approach for treating Asthma under evaluation. Bronchoscopic treatments for emphysema are potentially going to offer symptomatic treatments not previously available to those patients on maximal medication. Thus bronchoscopic lung volume reduction - valves inserted into hyperinflated areas of the lungs, and airway bypass (stents within the airways to allow deflation of hyperinflated lung) and most recently memory endobronchial coils are also in trial.

The indications for bronchoscopy continue to expand and we are fortunate to be at the forefront of these developments, as well as influencing national standards in this area, as secretary of the British Thoracic Society’s interventional pulmonology specialist Advisory group. This, and being a programme organiser and faculty of the Imperial College Advanced techniques in Bronchoscopy course for 10 years maintain our skills in this superspecialist area of respiratory medicine.

The role of bronchoscopy in the critical care setting is crucial and involves the potential to effectiveley manage acute airway decompensation, using skilled techniques and therapeutic adjuncts. This is part of the important training and clinical that specialist respiratory intensivists can impart.


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